1912949785 NPI number — PLEASANT VALLEY OPHTHALMOLOGY, PLLC

Table of content: DR. JACQUELINE CHAPMAN NORTH PSY.D. (NPI 1609803550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912949785 NPI number — PLEASANT VALLEY OPHTHALMOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLEASANT VALLEY OPHTHALMOLOGY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912949785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11825 HINSON RD
Provider Second Line Business Mailing Address:
STE. 103
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72212-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-223-3937
Provider Business Mailing Address Fax Number:
501-223-8656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11825 HINSON RD
Provider Second Line Business Practice Location Address:
STE. 103
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72212-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-223-3937
Provider Business Practice Location Address Fax Number:
501-223-8656
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
501-223-3937

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ3133 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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